Articles: critical-care.
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Intensive care is increasingly frequently used in the management of cancer patients. In order to determine whether and how critical-care facilities are used specifically for these patients, we performed a world-wide inquiry in anticancer centres. We mailed a questionnaire to 141 centres and received 84 responses (57.5%). ⋯ Data were obtained concerning the ICU organisation, the medical team, the nursing staff, the critical-care techniques and the anticancer treatments performed. Medical ICU appeared to be managed by physicians and nurses often qualified in both intensive care and oncology. These data suggest that oncological intensive care should be part of the training of oncologists and intensivists.
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Critical care medicine · Mar 1995
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialDouble-blind, randomized, multicenter study of doxacurium vs. pancuronium in intensive care unit patients who require neuromuscular-blocking agents.
To compare the neuromuscular-blocking and hemodynamic effects of doxacurium vs. pancuronium administered by intermittent bolus to intensive care unit (ICU) patients who required neuromuscular block to facilitate mechanical ventilation for > or = 24 hrs. ⋯ In critically ill patients requiring neuromuscular block for > 24 hrs, doxacurium was well tolerated without evidence of tachycardia and with a relatively prompt recovery profile.
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Critical care medicine · Mar 1995
Multicenter StudySurvey of critical care management of comatose, head-injured patients in the United States.
This survey was designed to study current practices in the monitoring and treatment of patients with severe head injury in the United States. ⋯ The survey data indicate that there is a considerable variation in the management of patients with severe head injury in the United States. The establishment of guidelines for the management of head injury based on available scientific data and moderated by practical and financial considerations may lead to improvement in the standard of care.
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The purpose of this study was to compare the cost of a day spent in an intensive care unit and a day spent on a general nursing unit. A descriptive design was used, based on patient level data, to examine and compare unit costs per day for each of the ICU and non-ICU portions of a patient's hospital stay. Records from 386 patients who were treated in a general medical/surgical ICU were analyzed. ⋯ The results suggest that the savings achieved by moving a patient from ICU to non-ICU care are considerable, particularly for less severe surviving patients. In making such decisions, however, clinicians must examine prospective benefits as well as costs. If the health outcomes are not influenced, the savings from substitution are considerable, and there is a strong economic argument for substitution.
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Clinical judgment in critical care is supported by a rich social network of care providers. The purpose of this study was to describe the social context in which the process of critical care clinical judgment occurs from the nurse's perspective. ⋯ Nurses and physicians were organized in hierarchies of nurse manager, resource nurse, charge nurse, and staff nurse or attending surgeon, fellow, chief resident, and resident. These parallel hierarchies allowed for checks on judgment both within and across professional lines. Rituals, such as nursing report, physician rounds, and flow sheet use, provided a context for a critique on judgment processes. Communication of judgment was frequently a casual, open conversation. At other times, differences in perspective could result in conflict. Communication between nurses and physicians has been associated with better patient outcomes. Critical care unit directors and managers can use an analysis of communication patterns to develop supports to clinical judgment.